Tag Archives: psychiatry

Boards.

To most, that’s just a word. To others, that one simple word can cause the most debilitating anxiety, an overwrought feeling in the pit of one’s stomach, an uneasiness that shakes the core of their being, and strike such an intense fear that courses through every vein in their body. Now do you understand? Brace yourself because it’s about to get real and you might want to sit down for this one.

I pride myself in always being honest and genuine and giving you glimpses into my life in med. school and as you may or may not know, it hasn’t always been pretty. In fact, I often say that “med. school isn’t all sunshine and rainbows” and for me, it has rained far more than the sun has shined.

If you need the long story, please refer back to my previous blogs so I can save you some time. For a quick recap, I had a rocky start. I got waitlisted, got accepted the day class started and then took a semester of personal leave to get my mental health in order after having two back to back deaths in my family and failing two courses because of that. In undergrad you can just pick up right where you left off or retake a class, well, not in med. school. There are more school policies than I can count and one of them is that not only do you have to retake courses but if you fail more than 2 then you have to repeat the entire year and ask for a chance to prove to them that you can make it. Talk about pressure, right? Thankfully, I was never in that position. I came back the next year, learned how to study, addressed my mindfulness, and killed it my first year. Granted, to me “killing” it is passing but I’ll have you know that I got A’s and high B’s in those courses that I previously failed, I can’t say that for the rest of the courses that year but I do know in medical school that a doctor that made straight C’s is still a doctor. I did well in second year, maintained my B average and passed my OSCE. The COMSAE was a different story though and actually where this tale begins.

The very first COMSAE I took was in January. To those unfamiliar with this term, it is the practice board exam for D.O. students that they have to pass before they take COMLEX level 1 aka USMLE Step 1 for D.O.’s. I actually wrecked my car on the way to the exam because the roads were so icy and hadn’t been salted. It was really bad. Thankfully I wasn’t hurt, but my car and another car were in bad shape. My taillight was hanging on by a wire on the way to school and my kind classmate helped me duct tape it until I could get it fixed! The night before the COMSAE, I stayed over at a classmate’s house because I was worried for her own mental health and wanted to be there as a supporting friend and a shoulder to cry on. You know what they say, no good deed goes unpunished so I wrecked the following morning. I cried all the way to school and found a way to gather myself up and go in there and take the COMSAE. I actually contemplated not taking it because I was so distraught but I knew that there was technically no punishment for underperforming so I just went for it. Granted we didn’t have to get a 400 on this, we weren’t even finished with courses for the year, and I had done ZERO board prep thus far (it was only January for goodness sake) but they still wanted us to get above a 250 for very good reason. Miraculously, I did. The worse that would come of not getting a 250 or above was talking to the dean about how to improve and I was so lucky to escape that madness, or so I thought.

The next COMSAE came in May. We had to pass to be able to sit through boards, and I failed it. I didn’t fail horribly, in fact I did better on it than I did on the COMLEX, but it wasn’t enough. My school put me on a prep track along with 40 or more classmates that had also failed. This wasn’t permanent and no one saw it, but we did have to pass before we took the real thing. After this month-long prep program put on by the school, I either benefitted slightly or I just did better on a different form of the exam because when I took the next COMSAE, I passed. If I didn’t pass this second comsae, my rotations would’ve been delayed. I got exactly what I needed to pass and my COMLEX level 1 date was a week away.

At this point, I was so over studying. I was so burnt out. I had been going hard since March, but thinking back it was more quantity over quality. I couldn’t study that entire week and my mind was not there. I got to the testing center that morning and I probably couldn’t even tell you my name. I felt like I blacked out during the second half of the exam because of testing fatigue. I started at 7:45am and didn’t get out until 4:15pm. This exam is 400 questions, 9 hours long, and there are no breaks besides your permitted 30 min. lunch break. Actually, there are 2 optional breaks but don’t take them unless you’re literally going to pee your pants because THEY TAKE TIME OUT OF YOUR ACTUAL EXAM. This is something I wasn’t aware of and I took my sweet old time, a good 8 minutes both times (16 minutes total WASTED) and this made me panic even more because I almost ran out of time. I was so crunched for time that I was trying to guess as best as I could and was frantically clicking through the last set of questions. At the end after I clicked submit, I was so angry, so upset, and felt that it was such an unfair exam to test my knowledge but you know what they say: life’s not fair and that is so painstakingly true.

I waited an entire month for my score. I cried, laughed, cried some more, panicked, and forgot. I tried my best to put it behind me but deep down I felt like I failed. Sure, everyone thinks that after they take step 1 right? Well I actually did. You never think it can happen to you until it does. It was one of the worst days of my life. I contemplated writing this the day after I failed, but I was SO motivated after seeing that score that I didn’t want to waste a single second and I wanted to get back to work ASAP. I had already completed half of my family med. rotation, was loving it, and my preceptor even gave me an A. As for the following 2 months, I studied by butt off. DIT clearly didn’t work for me, I know it works for many people but personally, it wasn’t the best program for me. This time, I tried boards boot camp, which is a program made specifically for D.O. students. I really liked this program but I found that it was so extensive and had over 360 hours of things to complete, I knew I’d never complete all of that before I went to take it a second time. That ALSO gave me anxiety which made my studying even worse. Nonetheless, I picked myself up, did the best I could, and studied with two other classmates who had also failed. I had heard about ~30 students out of 215 or so had failed. It was very disheartening to hear it had happened to others but honestly it was quite comforting to know that I was not alone in such an awful place.

I took the exam and then immediately started my psychiatry rotation. I actually felt better coming out of the exam that time. I still felt like I failed and was hoping for a miracle to just barely pass. I know my strength does not lie in standardized exams and that I will never be the student in the 600 or 700 range (Comlex max. score is 800, passing is a 400.) During this psychiatry rotation, as you might have heard through my other social media sites, I felt like I found my calling. A little bit of that passion inspired me to write this blog for you today. I loved every minute of it and also did very well in that rotation. I know I have what it takes, but for some reason, standardized exams get me every single time.

I got my score two days before I was scheduled to finish my last four weeks of my family med rotation. I was so excited to finish this rotation with this preceptor because he is my personal family doctor and also my mentor in the Rural Health Initiative program. It was set up to be the most perfect rotation but I didn’t even get to start. A classmate, the same one that studied with me who also failed, told me the Psych COMAT scores (Shelf exam for rotations) were up. I anxiously went to NBOME to see how I did because I thought I did really well. I didn’t find the exam difficult and I LOVE PSYCH but my scores for the psychiatry shelf were not there, there was a different set of scores waiting for me. I expected to get my scores for level 1 that day because usually you get an e-mail saying they’ve been released. I looked down for my COMAT score and I see two “Failed exams” back to back. I thought I misread something or this was a COMSAE score. “Surely I didn’t fail again, that can’t be possible, I should ask for a re-score” were the thoughts that flooded my mind. Deep down, I knew I didn’t need to re-score it, the NBOME never makes mistakes, and it actually took almost 2 months to get these scores so they’re probably as correct as they can possibly be and it was true. I failed. All of my practice COMSAE’s I passed, sure they weren’t with flying colors but they were well above a 400, my percentages were increasing on combank and comquest (question banks similar to UWorld for MD students) and I even ended my last question set with a 75% which was a win for me. I thought I was ready, but I wasn’t. I actually did WORSE on this exam than I did the first time and I have no explanation for that besides debilitating anxiety. My anxiety truly comes to a peak during exams and has been undiagnosed and untreated for years which leads me to talk about how important mental health is, especially in medical school.

No, you can’t just tell someone with anxiety to “get over it,” “just relax,” or “it’s all in your head”, because it doesn’t work – in fact that makes it worse so please don’t do that. Just because you can’t see a mental illness, doesn’t make it any less real. It doesn’t make you any less of a human being, it doesn’t make you any less worthy as a person, and it doesn’t define you or who you are. I’m so passionate about this that I want to make it my life goal to end the stigma on mental illness and mental health. I’m so tired of the negativity behind it. Over 21% of adults are affected by some sort of anxiety disorder, and I am included in that 42.5 million population. Since my second failure, I have made an appointment to get my anxiety under control and to finally address it being the 25 year old woman that I am. It’s time to control my anxiety and stop letting it run my life.

Sometimes people I don’t know will comment things like “can I be you” or “I can’t wait to be in your shoes” on my pictures or on my tweets. I always chuckle at this because some days I don’t even want to be me. If y’all knew what I’ve gone through, you wouldn’t want to either. Just because I have cool pens or highlighters or a cool purse and post about it, doesn’t mean my life is perfect or I have it all together. Probably more days than not I don’t have it all together. I’ve never been the perfect or “ideal” med. student, and I probably never will be, but what I’ve always been is myself, and that counts for something, somewhere. I have one shot left to take this exam. I’m actually going to a program in Florida called “Wolfpacc” that guarantees a pass on step exams. I’ve had several classmates who have failed step 1 or level 1 twice improve by 100 points, and also a now practicing DOCTOR that failed step 1 and step 2 both TWICE EACH that pointed me to this program. I started January 3rd and finish February 24 and am giving it my all because honestly what do I have left to lose?

I truly feel in my heart, as crazy as this may sound, that I’m meant to suffer and go through hardships in order to help others that may be in that same situation one day. I feel like I’m meant to go through challenges to shed light on the situation and be a beam of hope to someone else that has to endure it and if you’re that someone, I hope this reaches you.

You’re more than your number, and I know I need to take my own advice and listen, but we really are. So many doctors have told me that they’ve failed a board exam whether it’s step 1, step 2, or BOTH, and are STILL doctors today and got a residency. Yeah, it may be harder but it’s definitely not impossible and where there’s a will, there’s a way, and somehow we will make it through. I don’t know what my future holds, in fact, I’m not even sure I’ll be a medical student come April if I don’t pass this exam, but I DO know that I will do everything in my power to conquer this exam that has defeated me twice now and has defeated my friends and classmates alike. If you’re in this boat, I want you to know that it is NOT the end. Unless you’ve absolutely done all that you could, exhausted all resources and options, and the school dismisses you because you’ve failed 3 times and broken their academic policy, then it’s NOT over for you so I don’t want you to act like it is or even feel like it. SO MANY doctors fail boards, but no one talks about it. Why? Instead we shut ourselves out, isolate ourselves, and do everything we can to sweep it under the rug and pretend like it never happened. We are so ashamed that it happened yet never stop to think that we aren’t alone and it happens to even the best doctors.

A few of the administrators at my school loved to speak fear into the eyes of medical students – they probably didn’t mean to, that’s just how it felt on the other side being a student. It started first year getting talks about boards, and then the year after that getting told in a roundabout way that you won’t get a residency if you fail and it’s the absolute worst thing that could happen to you. Well it’s not. In fact, I saw a homeless man today – as I stopped to give him all the spare change I had, I couldn’t help but think how selfish I was to be this upset when there’s a man in front of me with no house, no food, and no money and here I am crying about a test. It really put things into perspective and how it can ALWAYS be worse than what it actually is.

Please don’t give up. I’m not, and you shouldn’t either, whether you’ve failed a class in high school, college, medical school, a board exam, an entrance exam, whatever it may be. Remember why you started, don’t quit, find a way. If you need time off, take it, if you need help, seek it, if you need to retake the class or test, do it. If plan A doesn’t work, guess what, there are 25 more letters in the alphabet.

And to those of you reading that for some reason don’t like me or my account or feel like you’re better than me and so many others that have struggled and failed because you passed on the first try, congratulations. If you feel the need to belittle me, criticize me, judge me or my journey, or my failures, go right ahead because I can PROMISE YOU that you won’t say anything worse than I’ve already told myself or how I’ve felt about myself. Your opinion of me does not matter, you don’t walk in my shoes, and you don’t live the same life that I do or anyone else for that matter. You cannot get to me because I am my own worst enemy. For those of you that truly act that way, shame on you and I’ll pray for you. As a patient, I’d actually take a doctor who struggled over someone who didn’t because you know what that shows me? That despite almost losing it all, they found a way to prevail and succeed in the midst of adversity just to help me. Just because I failed doesn’t mean I’ll be any less of a doctor, and I guarantee not a single future patient of mine will ever know about any GPA or board score nor even ask, and neither will yours! One exam doesn’t determine how great of a doctor you will be. Sure, a failure might close a few doors but when one door closes another opens. Sometimes we look so long and regretfully upon the closed door that we often don’t see the door that has opened for us. So keep your head up!

Sorry this was such a long post, I had a lot to say and there was no shorter way to not put it all out there. Please feel free to contact me at any anytime whether it’s on here, snapchat, Instagram, or twitter, I promise I read ALL of my messages and do my very best to help everyone that I can. I will be here for YOU, talk you off the ledge, and let you know that it’s going to be okay when I’m trying to make it myself. Please take care of yourself, you’ll do your patients no good if you aren’t well yourself. Life is not perfect and neither are we but I can guarantee that at the end of our journeys, it will be because they’re OURS and no one can ever take that from us.